Part of the NICHQ and Maternal and Child Health Bureau-led Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN) involves state teams determining where there are opportunities to improve systems so they can better reach underserved women and infants. In our special Underserved Population Series, we’ve highlighted IM CoIIN teams that have made strides in reaching underserved populations across different strategic focus areas for addressing infant mortality. These inspiring stories show that change is possible, and that there are ways to reach every mother and every child. Although the healthcare system is far from perfect, new strategies can be implemented to extended it to people who can’t access the help they need.

Across the United States, organizations and government agencies are creating new approaches to improve children’s health. Because we support innovation for helping children lead healthier lives, we’ve highlighted some of the most exciting initiatives we’ve seen in the last few weeks. Read on to learn how some groups are addressing critical health needs.

Sudden Infant Death Syndrome (SIDS) is the fourth leading cause of infant mortality in the United States, according to the Centers for Disease Control and Prevention. During SIDS Awareness Month in October, healthcare systems, government agencies and public health organizations are reaching out to providers and parents to educate them on what they can do to better protect infants.

In 2014, the obesity rate for children and teenagers between ages 2 and 19 in the United States increased to 17.2 percent, up from 13.9 percent in 1999. While various organizations and agencies are working to help children lead healthy lifestyles, there has been another trend in recent years that has come into play: gamification.

For women who have recently given birth, waiting at least 18 months before becoming pregnant again is essential as it allows the body much-needed time to recover and heal. Longer intervals between pregnancies also mean better birth outcomes and healthier babies. While there is no consensus on optimal interpregnancy interval, research shows that short intervals of less than 18 months and intervals longer than 60 months are associated with poor health outcomes.

Unplanned and complex births carry potentially avoidable health complications and costs to families and states. Broad healthcare payment and delivery reform is underway across the country to improve outcomes, enhance patient experience and reduce costs. Some states are capitalizing on these reforms to promote planned and healthy births by driving improvement in effective contraceptive use and postpartum follow up care. Their efforts create potential opportunities for cross-agency collaboration and integrate well with other initiatives, such as the Centers for Medicare and Medicaid Services’ Maternal and Infant Health Initiative and the Health Resources and Services Administration’s Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN).

Early childhood trauma – whether from unexpected acts of violence or entrenched, continuous influences such as chaotic home life or family violence – is pervasive and can have cumulative, life-altering impacts. The stress of childhood trauma releases hormones that physically damage a child’s developing brain. Children with toxic stress live most of their lives in flight or fight mode, making it difficult to learn in school and build healthy relationships.

For 25 years, the National Healthy Start Association (NHSA) has served as a leading voice in support of government policies and programs that serve pregnant women, babies, and families in vulnerable communities. NHSA works diligently to ensure optimal birth outcomes and elimination of disparities advocating for community-based services, such as outreach, home visitation, care coordination, health education, health and depression screening, and paternal engagement programs.

Learning leaders’ styles is a great first step towards engaging them in quality improvement (QI) efforts. The next two steps -- establishing a vision and aligning aims with the organization -- are important both to securing leadership buy-in and to the work’s ultimate success. Undertaking these actions early on allows for more substantive conversations about QI plans and opportunities that can foster interest at every level of the organization.

The Wisconsin Providers and Teens Communicating for Health (PATCH) program is helping to reduce teen pregnancy rates in Wisconsin by enhancing communication between teenagers and their healthcare providers. The PATCH program trains and employs Teen Educators who then educate medical professionals on how to communicate with younger patients, with a particular focus on sensitive subjects, including sexual and reproductive health.

Missouri aims to move the state’s hospitals away from self-designation for levels of risk appropriate care to better support perinatal regionalization—the idea that a system exists to designate where babies are born or transferred according to the level of care they need at birth—and improve health outcomes for moms and babies.

Increasing the number of patients with sickle cell disease (SCD) who receive regular care from knowledgeable providers is one of the three main goals of the Sickle Cell Disease Treatment Demonstration Program (SCDTDP), for which NICHQ is the national coordinating center. But what happens to patients with SCD who have trouble initiating or remaining in treatment? Through the SCDTDP, community health workers (CHWs) are a critical layer of support for these at-risk patients.

A healthy pregnancy starts before conception, but almost half of pregnancies in the U.S. are unplanned. This increases the risk of poor outcomes for both moms and babies. Planning can help women better prepare themselves for pregnancy, and it all starts with a single question from their doctors: Would you like to become pregnant in the next year? The One Key Question® (OKQ) initiative from the Oregon Foundation for Reproductive Health (OFRH) encourages healthcare providers to ask every woman this specific question because it changes the context of other health factors.

Although great strides have been made in recent years, infant mortality remains a problem in the United States. The infant mortality rate has declined – dropping 13 percent between 2005 and 2013 – while still leaving the U.S. far behind many industrialized nations.

Across the United States, organizations and government agencies are creating new approaches to improve children’s health. Because we support innovation for helping children lead healthier lives, we’ve highlighted some of the most exciting initiatives we’ve seen in the last few weeks. Read on to learn how some groups are addressing critical health needs.

At the outset of every project, we determine how it will relate to our three areas of focus—bridging health and healthcare, improving systems of care, and increasing support for healthy beginnings. Recently, three new projects have touched on these foundations, progressing towards improvements in systems for children’s health and outcomes for families.

While the country’s rate of sudden infant death syndrome (SIDS) has dropped by more than 50 percent over the past two decades, SIDS continues to claim the lives of about 1,500 U.S. infants each year. SIDS is the leading cause of death for infants and is highly correlated with unsafe sleep practices, which is why the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN) has made safe sleep practices one of its six focus areas. By helping to eliminate persistent but avoidable disparities in SIDS rates, addressing unsafe sleep practice with underserved populations can reduce infant mortality for all.

Opioid abuse is at a crisis point in the U.S., and it’s affecting more and more babies in utero. Babies born to women who use opioids are cutoff from those drugs at birth, which puts the babies at risk for a cluster of neurological, gastrointestinal and respiratory symptoms that are collectively referred to as neonatal abstinence syndrome (NAS). Nationally, NAS has increased fivefold since 2000, and this rate, too, has become steeper in the past few years. In 2009, one infant was born with NAS per hour. By 2012, one baby was born with NAS every 25 minutes.

MCH Practice Fellow Avery Desrosiers has been part of the IM CoIIN team during her time at NICHQ. Over the course of her work, she's learned about how quality improvement can affect maternal and child health, how encourages innovative changes within specific communities to improve health outcomes for vulnerable populations.

For families with children who have special healthcare needs, finding an optimal care system can sometimes be a challenge. While quality improvement is used a great deal in healthcare, a handful of parents participating in a NICHQ-led QI training are finding it can also help parents achieve their individual goals for improving as caregivers and their children’s quality of life. Shu-Chiung Chou recently participated in our ABC’s of QI course, offered to members of Family Voices, a national nonprofit organization working to achieve family-centered care. Chou was eager to join to learn how to better manage her daughter’s care and share what she learned with us.

Maternal mental health is a key part of moms’ and children’s health outcomes. According to the World Health Organization, 10 percent of pregnant women and 13 percent of postpartum women have mental health concerns, such as depression. Fortunately, these cases are largely treatable, especially if doctors are able to intervene early on.

For the estimated 100,000 Americans diagnosed with sickle cell disease (SCD), a medication called hydroxyurea (HU) can protect against pain outbreaks, lessen the need for blood transfusions and even reduce mortality. But while HU is the only drug approved by the FDA for preventing SCD-related complications, only 42 percent of adults with SCD were taking HU in 2014.

The National Healthy Start Association's (NHSA) Where Dads Matter initiative helps engage men and dads in maternal and child health to help support health outcomes. NHSA President Kenn Harris recently spoke with us about Where Dads Matter, its impact and the role male caregivers play in MCH programs.

Quality improvement means making long-term changes that can be adapted and sustained in different environments. Testing is one of the essential steps in optimizing a change idea so that it can improve a specific element within public health.

Data sharing is one of the most significant barriers between city and state health departments when it comes to reducing infant mortality. States and cities accumulate a great deal of data at various levels on birth outcomes and maternal care, but they don’t always make it readily available to each other.

Programs from healthcare providers, government agencies and other organizations help improve children's health by addressing new needs and closing gaps in care. This month, we've found innovative and inspirational examples touch on subjects like children's sleep during hospital stays and efforts to improve in-school care.

Two articles related to NICHQ’s portfolio of sickle cell projects are featured in a special sickle cell supplement of the American Journal of Preventive Medicine out today, in advance of World Sickle Cell Day June 19.

Fostering the creation of healthy families by choice, not chance, is not a new idea. Organizations and agencies are working to improve pregnancy planning, spacing and preventing unintended pregnancies. Given the high rates of unintended pregnancy in the U.S., action is needed from all stakeholders–consumers, health providers, policy makers–in proactively supporting this critical conversation.

“Follow the Leader” isn’t always a game that should be played during quality improvement (QI) work. In fact, often, QI teams need to be proactive about engaging their leaders, creating a partnership to support change initiatives. To do that, leaders might have to be pushed out of their comfort zones.

A new video series is showcasing how healthcare providers in Texas are successfully implementing the Ten Steps to Successful Breastfeeding, a set of evidence-based practices hospitals can follow to increase breastfeeding initiation and duration by new moms. Created by the Texas Department of State Health Services, this 10-video series features healthcare providers sharing their strategies for success on the pathway to improvement.

With the projection that more than half of the nation’s children will be part of a minority race or ethnic group by 2020, the need to address health equity has never been stronger.Equity in healthcare is the idea that everyone has the same access to quality care, regardless of social, economic, demographic or geographical differences. This ideal is not a current reality in the U.S. healthcare system. There are many barriers hampering health equity and the overall health of America’s children.

More mothers in New York will soon experience better improvements in hospital maternity care, as 21 more hospitals join the state’s Breastfeeding Quality Improvement in Hospitals Collaborative (BQIH). Cohort A saw 12 New York hospitals work together and use quality improvement (QI) methods to change their systems and practices to better support a mothers choice to breastfeedings. Cohort B will see 20 new hospitals participate in the collaborative, building off the momentum and learnings from their predecessors.

Unplanned pregnancies can present a tremendous challenge for many women, healthcare payers and the community, and are associated with a number of negative health outcomes, such as delayed prenatal care and premature births. Efforts like the Centers for Medicare and Medicaid Services’ (CMS) recent guidance and the Collaborative Improvement & Innovation Network to Reduce Infant Mortality (IM CoIIN) have improved maternal and infant health outcomes, while also highlighting the $10 billion cost burden Medicaid expends on unplanned births.

Across the United States, organizations and government agencies are creating new approaches to improve children’s health. Because we support innovation for helping children lead healthier lives, we’ve highlighted some of the most exciting initiatives we’ve seen in the last few weeks. Read on to learn how some groups are addressing critical health needs.

The Best Babies Zone (BBZ) Initiative has been working on the social determinants of health for four years. In 2012, BBZ was launched to address the social, economic and environmental factors that contribute to poor birth outcomes. With funding from the W.K. Kellogg Foundation, three small pilot “zones” were launched in Cincinnati, OH, New Orleans, LA, and Oakland, CA. In these cities, a lead organization connects and convenes partners from across sectors, creating possibilities for innovative projects that address the root causes of infant mortality in that community.

In the 1930s, Finland’s infant mortality rate reached 65 deaths per 1,000 live births, leading to the 1938 introduction of baby boxes—kits that include a mattress, bedding, diapers, a box that serves as a crib and other necessities. By 2015, that rate had dwindled to an estimated 2.52 deaths per 1,000 live births. In 2014, there were 3,500 sudden unexpected infant deaths in the United States, 25 percent of which were caused by accidental suffocation or strangulation in bed. Learning from Finland’s success, organizations in the U.S. are beginning to offer their own baby boxes to new families.

While a higher percentage of Rhode Islanders have health insurance compared to the U.S. average, achieving health equity has been a challenge for the state—especially for its infant mortality rate. Now, the Rhode Island Department of Health is targeting key social factors that impact infant mortality in minority groups, including education, income and stress. The Rhode Island Commission for Health Advocacy and Equity was created in 2011 to address the inequity, by bringing together state agencies to focus on the social determinants of health—typically defined as the wider set of forces and systems shaping the conditions of daily life. Aligning the efforts of those inside and outside the state is also key.

Reducing the rate of pre-term birth is a major priority for state health agencies and a growing concern for state Medicaid programs. Medicaid agencies provide coverage for over half of the nation’s births each year and pay for a higher rate of premature or low-birth weight babies than the private insurance market (10.4 percent versus 9.1 percent). Pre-term birth, a birth that occurs prior to 37 weeks of gestation, is the leading cause of infant mortality in the United States. Early delivery is associated with a host of long-term health issues for the infant, including sight and hearing loss, cerebral palsy and developmental and intellectual disabilities.

Wyoming is improving its birth outcomes one downloader at a time. An interactive mobile app—Due Date Plus—that the state Medicaid office developed for pregnant women is redefining prenatal education and transforming how Medicaid meets the needs of its pregnant population.

It is becoming increasingly clear that efforts to improve risk-appropriate site of delivery may benefit from close collaboration among perinatal care providers, payers and public health organizations. State health departments and state hospital associations often manage repositories of population-level perinatal data while perinatal quality collaboratives can engage front-line providers. Collaborative partnerships among these entities can facilitate improved outcomes at the population level.

Through a Healthy Weight Initiative at the Greater New Bedford Community Health Center, well over 200 kids have learned about monitoring sleep routines, fruit and veggie intake, screen time, physical activity and sweetened beverages. It’s a focus on healthier lifestyles and better choices, not weight loss, which is helping kids and families to see results.

Engaging pilot sites to test out change ideas and collect data is one of the best ways to learn how to make change at a local level. Pilot sites can test ideas and assist with planning and implementing a project “on the ground” with individuals in a project’s target audience. If pilot sites are challenged around collecting data to drive their improvement efforts, here are six tips to support them.

Children greatly benefit from having active paternal figures in their lives. According to the State of the World’s Fathers report, it leads to improved mental health in children, higher immunization rates and support for women who are breastfeeding. The creation and availability of educational resources that encourage male involvement are crucial to achieving that. Knowing this, the California WIC Association (CWA) created "Engaging Men & Dads at WIC: A Toolkit" to help the local WIC (Women, Infants and Children Supplemental Nutrition Program) organizations better connect with dads.

An ongoing effort from the Illinois team involved in the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN) is to get 90 percent of very preterm infants in Illinois delivered in Level 3 perinatal facilities. These facilities feature neonatal intensive care units (NICUs), where a combination of leading-edge technology and specially trained staff can vastly improve health outcomes for high-risk babies.

With both large urban and rural areas in Texas, sharing consistent and accurate information about the benefits of breastfeeding with mothers and healthcare workers is an enormous undertaking. One statewide initiative, the Texas Ten Step Star Achiever Breastfeeding Learning Collaborative, is harnessing the power of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) staff, using them as conduits for communicating evidence-based practices and offering guidance to both mothers and healthcare providers.

Forget the old marketing tactic of shouting loud and often. Mario Drummonds, MS, LCSW, MBA, the CEO of Strategy Interactions, and a participant in the NICHQ-led Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN), shares four strategies for building a public health social movement to increase state and national attention on your healthcare issue.

In South Carolina, half of all pregnancies in 2010 were unintended, primarily due to either lack of or failed contraceptives. Within the South Carolina Medicaid population, almost 79 percent of women defined their pregnancy as unintended. This is particularly troubling because births resulting from unintended pregnancies are linked to adverse maternal and child health outcomes and myriad social and economic challenges. To reduce this percentage, South Carolina Medicaid began a policy change in 2012 aimed at increasing the use of immediate postpartum inpatient insertions of long-acting, reversible contraceptives (LARCs).

The National Center for Medical Home Implementation has named NICHQ’s CHIPRA Massachusetts Medical Home Initiative an “innovative and promising practice” in pediatric medical home implementation. The initiative focused on helping 13 pediatric practices in Massachusetts successfully implement a medical home model of care. Unique to the project was the use of an internal practice transformation facilitator (PTF)—a motivated individual currently employed within the practice—to manage the day-to-day implementation needs of the pediatric medical home transformation.

When Nicole Acosta delivered her first child in May 2013, she knew she wanted to breastfeed, but she didn’t get as much support as she’d expected at her hospital, Good Samaritan Medical Center in West Islip, NY. Despite an uncomplicated delivery, no one suggested immediate skin-to-skin contact—a practice known to increase the likelihood of breastfeeding success. By the time she had her second son in June 2015, things had certainly changed at the hospital.

It has been more than 50 years since the Surgeon General’s report on the adverse health impacts of smoking. However, maternal smoking during pregnancy remains a persistent problem that healthcare and public health professionals have been unable to eliminate.

Recruitment is open for hospitals in New York State to join the state’s Breastfeeding Quality Improvement in Hospitals (BQIH) Learning Collaborative. If the results of the predecessor cohort of hospitals is any indication, these new recruits are in for some big changes.

A baseline report shows that only 15 percent of infants born in South Texas (Health Service Region 11) in 2009 were exclusively breastfed on their second day of life compared to 42 percent of infants in Texas overall, and as many as 55 percent in other parts of the state. An increase in exclusive breastfeeding in the Valley could not only increase the state’s overall rate, but could provide a roadmap for other similar communities to follow to improve the health of their residents.

Today’s parents and parents-to-be rely a great deal on the Internet, print and broadcast media to inform their childcare and parenting practices. Yet in a recent study of magazines targeting women of child-bearing age, more than one-third of images showed babies in unsafe sleep positions (e.g., on their stomachs) and more than two-thirds showed babies in unsafe sleep environments (e.g., in a crib with blankets). Thousands of precious lives could be saved each year if every parent and caregiver had a clear picture of what it takes to protect their babies during sleep.

NICHQ, along with partners AMCHP and the UNC Center for Maternal and Infant Health, is turning the session “Improving the Health of New Mothers: Building Woman‐Centered Postpartum Systems of Care” into a free public webinar. We invite you to join us on Feb. 2, from 3:30-5 p.m. ET

When it comes to sustaining change, many of the critical elements required in leading change—creating urgency, having a vision and strategy, removing obstacles, solidifying gains—are all still required. But one key element to make sure change sticks and gets anchored to a culture is to nurture a coalition of formal and informal leaders that support the ongoing improvement effort.

In the weeks following childbirth, mothers must adapt to plunging hormones, recover from birth and learn how to feed and care for a new infant. Amid these challenges, moms receive minimal support from the healthcare system. Postpartum visits are typically scheduled four to six weeks after birth, leaving moms to cope on their own for more than a month. Moms need more support in the weeks following birth.

More and more there is emphasis on partnering with patients and families to improve the quality and safety of healthcare. We advocate for the use of patient/family advisory councils and patient/family partners on improvement committees but, most often, we talk about these interventions in the acute care or chronic care environment. What we miss a fair share of the time is putting an emphasis on promoting partnerships during the everyday well-visit and sick-visit interactions—the same visits that have the potential to build and support a culture of partnership and engagement across the care spectrum!

Coaching isn’t just ingrained in me, it’s ingrained in NICHQ. As we work with partners and team members at every level, we aim to be a coach that provides guidance and builds confidence. We offer best practices and support teams to think about sustainable approaches for applying, adapting and testing those ideas within their own settings and communities.

The Plan-Do-Study-Act (PDSA) cycle is a fundamental tool in the quality improvement tool belt. PDSA cycles are used to test, implement and spread change ideas in a systematic way. Regardless of your improvement framework—collective impact, the breakthrough series, etc.—PDSAs can be used.

Changing a habit is not easy, even when you know it is “good for you.” The same goes for changing healthcare systems. The benefits of breastfeeding are well known, and supported by the World Health Organization, the Joint Commission, and many other healthcare accreditation and oversight agencies and experts. However, many hospitals struggle to create environments that support mothers who choose to breastfeed.

Childhood malnutrition. Infant mortality. Childhood obesity. Health inequalities and disparities. These are just some of the most demanding problems facing those who work to improve child health. However, these big issues are often seemingly intractable. How do you move the needle when previous efforts have yielded such meager results? One answer may lie in the concept of positive deviance.

A vast universe of symptoms, medications, complications, specialists and tests constantly surround my friend Julie. She is 38 and has Type 1 diabetes (T1D), which she was diagnosed with at age 10. Her quest for a long and prosperous future of good health is both harrowing and inspiring.

From my recent experience at the Infant Mortality Summits, a meeting of the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality, it seems that the time is ripe for the widespread growth of quality improvement (QI) strategies in the public health arena.

Learning often begins when facts contradict our assumptions. While attending the kickoff summits of the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality in July, I became aware of at least two facts that contradicted my previous assumptions: (1) that infant mortality rates for non-Hispanic blacks are higher in the upper Midwestern states than they are in the deep South and (2) that the declines in infant mortality in several southern states over the past decade have been steeper than anywhere else in the country.

I was recently invited to host the World Congress Patient Engagement Summit in Boston. The event promised to “leave behind theory and bring about actionable change with actionable solutions to engage patients and move the needle on clinical outcomes and community health.” And, it lived up to this billing.

As NICHQ’s faculty chair for Best Fed Beginnings, a national initiative that supports hospitals seeking Baby-Friendly designation, I am frequently exposed to pushback regarding the improvements required for a hospital to achieve this designation. Recently, an article published in the Washington Post portrayed Baby-Friendly practices as a problematic set of policies that “force” a new mother to breastfeed against her wishes. Nothing could be farther from the truth.

In support of National Sickle Cell Awareness Month, NICHQ invited Fatima Oyeku, a woman living with sickle cell disease, to share her perspective. “Maybe I'm just being overly optimistic, but I honestly think SCD could be eradicated if more people knew their trait status and have the opportunity to make an informed decision about having children,” she says.

As a new mom, I found myself searching for a true guiding presence as I tried to make decisions about caring for my daughter and myself. I knew I wanted to breastfeed her and I assumed it would be easy. I assumed the stars would align and she and I would be deliriously connected and she would be nourished. I assumed a hungry baby and a food source were enough. Not quite.

August is typically a month for relaxing, vacationing and taking long weekends to enjoy the warm weather. At NICHQ, we get our share of R & R, but August 2014 is also a particularly busy and exciting time! In August, we celebrate National Breastfeeding Month and World Breastfeeding Week (August 1-7), and as part of that, I am excited to help launch NICHQ’s new breastfeeding project with the New York State Department of Health.

Compared to other Western countries, infant mortality in the US is shockingly high. High infant mortality is a social problem that can only be solved through massive collaboration and out-of-the-box innovation.

The concept of collective impact is in NICHQ's DNA. All of our work is in some way about bring together participants from difference sectors committed to a common agenda to solve complex social problems. Until recently, we didn't have the benefit of the language or framework.

There are many broader influences that affect children’s health outside of the clinical setting. This certainly includes the bullying that happens on our ball fields that can lead to physical injury, social problems, emotional problems, mental health problems (e.g., depression, anxiety), and even death. Not to mention bullying can turn children off from physical activities and this can potentially lead to obesity. As an organization that aims for all children to achieve their optimal health, there is much work to be done…together.

To more accurately reflect our purpose, we are making a change in our name, from “healthcare” to “health.” NICHQ’s purpose has always been to improve children’s health. That is our passion and now our name is aligned.

If we really want to improve children’s health, we need to focus not just on improving the quality of care children receive when they go to the doctor’s office; we need to change all influences that affect a child’s health. This includes modeling and practicing healthy behaviors at home, in school and in the community.

Many years later, the life lessons I learned from my son's first-grade teacher in 1998 are still profoundly influential, especially when viewed through the lens of quality improvement, a framework I learned later in life.

Improvement science teaches us to view outcomes—such as health—as the inevitable product of a system, with the implication that achieving improved outcomes requires changing the system itself. A deep understanding of the system and how it functions can enable smarter decisions about selecting high leverage changes in order to improve system performance.

If you’ve read anything about obesity in the lay press over the past week, you already know that there has been a decline in the prevalence of obesity in American preschoolers.This news is both exhilarating and anxiety provoking. Celebrating too early could distract from the fact that there is so much more work to be done, especially for our most vulnerable children.

We have a long way to go before we get a gold medal in child health outcomes. I suggest we begin in a humble place – with the recognition that, while we may have much to teach other countries, we also have a lot to learn.

Want to improve the healthcare system from a systems perspective? Develop systems which allow for time, continuity, relationship, trust, authentic sharing, the telling and hearing of the patient’s whole story at each healthcare encounter. Create system change which positions clinicians to use tools such as emotional intelligence and motivational interviewing to ensure optimal sharing and comprehension.

When I first saw McDonald’s Olympic themed advertising that shows Olympians biting their metals contrasted with good looking, fit, young adults biting into chicken nuggets with the tagline, “The greatest victories are celebrated with a bite,” the marketing professional in me thought that was very clever. The parent and healthcare professional in me were horrified.

I’ve been thinking about innovation a lot lately, in large part due to a renewed commitment at NICHQ to be a hub for creating and spreading innovations. I am so excited about this commitment because I know that new ideas and new approaches—and building them together—will help create a world in which all children achieve their optimal health.

The mantra in quality improvement is “every system is perfectly designed to get the results it gets.” Regardless of your system of choice—your workplace, your home, your community—you’ll need knowledge to improve the system and get the results you want. It’s impossible to be a change agent without being a knowledge seeker first.

Now that I have the opportunity to work for a quality improvement organization with a vision of ensuring each child achieves his or her optimal health, and to process this information through the lens of my own experiences (personal and professional), my heart still breaks for those children harmed by bullying…AND I see great opportunities for improvement.

For as long as I can remember, I have been working to make things more organized, effective and efficient. I have spent countless hours organizing and reorganizing things in my life – everything from my son’s toys and games to the storage of our digital photos. It shouldn’t be surprising, then, that I have spent over a decade in project management and just over a year ago, found my way to NICHQ and discovered quality improvement science.

Now that I have the opportunity to work for a quality improvement organization with a vision of ensuring each child achieves his or her optimal health, and to process this information through the lens of my own experiences (personal and professional), my heart still breaks for those children harmed by bullying…AND I see great opportunities for improvement.

I know the tides are beginning to turn. Recent reports show breastfeeding rates are increasing in the US. The journey back to a more supportive breastfeeding culture has begun in this country. But I wonder whether there is more we can do to accelerate this process, so that from this generation forward there is no question and no need to choose.

I love Halloween. For one day every year, I get to try something new, look totally silly, celebrate fear and play with possibilities, all without the usual external or internal constraints. Can you imagine what life would be like if we had that freedom all the time?

It never ceases to amaze me what I learn from my children, especially the youngest ones – my eight-year-old twin daughters. I’ve been working in the quality improvement field for longer than they’ve been alive. But now they’re the ones teaching me about it!

I had never heard of the concept of a medical home before coming to NICHQ, but I’ve now seen what is possible in a patient-focused system where primary care physicians and specialists coordinate to deliver high-quality healthcare. In situations like mine, where there are no established protocols to follow, the need for a medical home is most critical—and paradoxically, most lacking.